Drug-interactions of azole antifungals with selected immunosuppressants in transplant patients: strategies for optimal management in clinical practice

Lempers, Vincent J.; Martial, Lisa C.; Schreuder, Michiel F.; Blijlevens, Nicole M A; Burger, David M.; Aarnoutse, Rob E.; Brüggemann, Roger J. M.

doi:10.1016/j.coph.2015.07.002

Cited by 71 publications

(42 citation statements)

References 40 publications

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“…The nonadherent patient may have difficulties in maintaining dosage and may suffer from inadequate exposure to antifungal, adverse effects [54], a risk of drug interactions [55–57], and microorganism resistance, commonly observed in azole antifungals [10, 11, 58]. Miconazole acts by altering the cell membrane permeability and is considered the antifungal of choice for topical treatment of denture stomatitis in healthy patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Propolis on the Denture Stomatitis Treatment in Older Adults: A Multicentric Randomized Trial

Pina

Lia

Berretta

et al. 2017

Evidence-Based Complementary and Alternative Medicine

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Our hypothesis tested the efficacy and safety of a mucoadhesive oral gel formulation of Brazilian propolis extract compared to miconazole oral gel for the treatment of denture stomatitis due to Candida spp. infection in older adults. Forty patients were randomly allocated in a noninferiority clinical trial into two groups. The control group (MIC) received 20 mg/g miconazole oral gel and the study group (PROP) received mucoadhesive formulation containing standardized extract of 2% (20 mg/g) propolis (EPP-AF®) during 14 days. Patients were examined on days 1, 7, and 14. The Newton's score was used to classify the severity of denture stomatitis. The colony forming unity count (CFU/mL) was quantified and identified (CHROMagar Candida®) before and after the treatment. Baseline characteristics did not differ between groups. Both treatments reduced Newton's score (P < 0.0001), indicating a clinical improvement of the symptoms of candidiasis with a clinical cure rate of 70%. The microbiological cure with significant reduction in fungal burden on T14 was 70% in the miconazole group and 25% in the EPP-AF group. The EPP-AF appears to be noninferior to miconazole considering the clinical cure rate and could be recommended as an alternative treatment in older patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Propolis on the Denture Stomatitis Treatment in Older Adults: A Multicentric Randomized Trial

Pina

Lia

Berretta

et al. 2017

Evidence-Based Complementary and Alternative Medicine

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“…Potentially, the interaction may also be explained by increased bioavailability of CsA due to imatinib-induced inhibition of the P-glycoprotein efflux pump in enterocytes [14]. We anticipated that concomitant use of other CYP3A4 substrates might influence the result of adding imatinib to CsA [15]. Four patients used voriconazole ( n = 1) or fluconazole ( n = 3), both before and after initiation of CsA.…”

Section: Discussionmentioning

confidence: 99%

A clinically relevant pharmacokinetic interaction between cyclosporine and imatinib

Atiq

Broers

Andrews

et al. 2016

Eur J Clin Pharmacol

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PurposeCyclosporine A (CsA) and imatinib are both CYP3A4 and P-glycoprotein substrates. Concomitant use after hematopoietic stem cell transplantation (HSCT) for chronic myeloid leukemia (CML) or Philadelphia chromosome-positive (Ph+) acute lymphatic leukemia (ALL) may therefore result in a pharmacokinetic interaction. Although case reports and a recent small study in children indeed suggested there is a relevant pharmacokinetic interaction, a larger study in adults is lacking. In this study, we assessed the presence and extent of this interaction in patients with CML or Ph+ ALL undergoing HSCT.MethodsFrom a large database containing data of all patients receiving HSCT in our center between 2005 and 2015, we selected 16 patients using this drug combination. The average dose-corrected CsA concentration was calculated before and after initiation of imatinib.ResultsThe average dose-corrected CsA concentration increased during imatinib use in all patients, on average by 94 % (p < 0.001). Based on measured drug concentrations, the CsA dosage needed to be reduced, on average, by 27 % after initiation of imatinib (p = 0.004).ConclusionsImatinib significantly increases CsA concentrations in HSCT patients, putting these patients at increased risk of CsA toxicity. We recommend intensive monitoring of CsA concentrations after initiation of imatinib; a pre-emptive CsA dose reduction of 25 % might be considered.

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“…Meanwhile, the interaction may also exist between drugs and foods (food-drug interaction), as well as drugs and herbs (herb-drug interaction). This action can be synergistic, antagonistic or a new effect neither produced by its own [1,2]. A drug's efficiency is affected 4 by the degree of its bind to plasma proteins because the most drugs are transported as complexes combined with plasma proteins, and only free drugs can cross the biological membrane to produce pharmacological effects [3,4].…”

Section: Introductionmentioning

confidence: 99%

Studies on the interaction between promethazine and human serum albumin in the presence of flavonoids by spectroscopic and molecular modeling techniques

Wang

et al. 2016

Colloids and Surfaces B: Biointerfaces

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Drug-interactions of azole antifungals with selected immunosuppressants in transplant patients: strategies for optimal management in clinical practice

Cited by 71 publications

References 40 publications

Efficacy of Propolis on the Denture Stomatitis Treatment in Older Adults: A Multicentric Randomized Trial

Efficacy of Propolis on the Denture Stomatitis Treatment in Older Adults: A Multicentric Randomized Trial

A clinically relevant pharmacokinetic interaction between cyclosporine and imatinib

Studies on the interaction between promethazine and human serum albumin in the presence of flavonoids by spectroscopic and molecular modeling techniques

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